Hmmmm, I would wager that this is where the wonderful world of Advanced Directives comes into play.... The patient pre-planning what treatments they want to avoid conflict with family members.

If it were me & I had the DNR paperwork & was unable to breathe without mechanical assistance, let me go on to the next phase, uninhibited....

Jun 2, '07

Yes in very rare cases where stratification forms are used. I know HCA hospitals use these and they are awful!

Jun 2, '07

I often see "DNR, intubation ok" or "DNR, pressors ok." I find these difficult to deal with, as what it really means is "no chest compressions, no shocks"

Jun 28, '07

My question is how can you resusitate if you can't circulate the meds you are infusing.......so you shoot the ACLS drugs and they sit in the vein....no compressions mean not circulating....I hate when the family wants the meds but no shock...you know "Chemical codes".....UGH

Jul 22, '07

As far as Intubations: I have often heard that since they are not in cardiac arrest, a ventilator is not "coding" a patient. In response to this we now often asked about both wishes for codes and intubation. We now have DNR/DNI (Do Not Intubate) patients.

As far as Chemical Codes: I personally like them for that very reason. Scenario: Family is in extreme denial, won't make patient DNR. They will often agree to a Chemical Code (I have found that it is usually the nurse/md pushing for the Chemical Code, not the family). The result is that I know that the patient is now for all purposes a DNR, can pass away in peace, but the family usually does not feel guilty about "not doing enough", because they "know" that meds can save people and don't think about circulation.

Can a DNR be intubated and ventilated? Provided there isn't cardiac arrest. Say in the case of respiratory failure?

Yes, DNR pts can be intubated and put on vents. If they don't want to be intubated, they also sign for DNI (do not intubate) in addition to DNR.
You may see advance directive that says DNR/DNI.

Aug 28, '07

This subject touches a nerve with me... my beloved Mom died this early summer while being treated in a hospital and they pulled out ALL THE STOPS including broken ribs, aspiration from intubation and a Dilantin drip from seizures after being brain dead after several minutes. All this performed despite having a very thorough and detailed advance directive in the BACK OF HER CHART that never got noted.

She specifically detailed that she did not want any ACLS or compression, or ventiliation support but wanted to die a peacefull and natural death. Unfortunately for her, and every member of her family we had to endure 5 days of fighting with the nursing staff to not only visit her in ICU but battle to provide her with a voice.

It was horrific to us and also no doubt to her in some ways but I can say that now, more than ever I NEVER take care of a patient without knowing their code status.

My father is trying to implement a nationwide law called "Jeannies Law" that will protect anyone from having to suffer the injustice and indignity. Sorry to rant but this topic really steams me, more now than ever.

Sep 6, '07

haunted, I am sorry that you have had to go through all of the trauma of this evil medical system. I know I am only a nursing student, but as an NA at a local hospital, I have seen too many times pt wishes were not honored for whatever reason. I hope your father gets "Jeannies Law" into effect, and I hope that other people will begin to see the importance of informing family, hospital staff, and lawyers of their personal and final wishes.

Sep 13, '07

i can tell you that in missouri, all dnr forms i have seen have the option to pick and choose what you want. this is rediculous! it is like trying to make a cake with half the ingredients. they can choose to be given cardiac meds but no compressions, or cpr and defibrilator only no medications, or no cpr but wants to be intubated and placed on a vent" in case they get better???".

haunted, my heart goes out to you. my grandmother was diagnosed with lung ca in 2001. it was a hylar mass and the right lung was already collapsed. i talked to her honestly, and gave her the choices at hand. she chose to be dnr and have hospice so she could die at home. i took 6 months off of nursing, to take care of her. not all people have that opprotunity, so please do not think that i judge those who can not provide in home care. i handled all her meds through hospice and the doc. i started and maintained her iv. inserted and kept clean her foley.the last several days were very hard. i was doing ivp meds every hour.but i am glad that i had the opprotunity to give her the care she needed. yea someone else could put in the foley, but it was les embarssing for me to do it.
tiredbraveheart